<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
	<head>
		<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
		<meta http-equiv="X-UA-Compatible" content="IE=8" />
			<title><!--%nom_fonction%--></title>
			<link rel="stylesheet" type="text/css" href="../../css/main.css" />
            <link rel="stylesheet" type="text/css" href="<!--%css_module%-->" />

            <!--link rel="stylesheet" type="text/css" href="../production/contrat/list.css" /-->
            <!-- link rel="stylesheet" type="text/css" href="../css/list.css" /-->
			<!--link rel="stylesheet" type="text/css" href="../production/modadmin/list.css" /->
			    <!--[if IE 7]>
            	<link rel="stylesheet" type="text/css" href="../css/ie7.css" />
            	<link rel="stylesheet" type="text/css" href="form_ie7.css" />
            <![endif]-->
            
            
	</head>
	<body>
		<div id="sf_menu1">
			<h3><!--%nom_module%--></h3>
			
		</div>
		
		

<div class="corps1">
	<div id="information_erreur" >
	        		<ul id="message">
	        			<!--%loop:messages%-->
	        			<li><!--%message%--></li>
	        			<!--%endLoop:messages%-->
	        		</ul>
	</div>
	<div class="cleared"></div>
	<div id="br"></div>
	
	
	<div class="imgleft2"></div>
	<div class="imgmiddle2">
        <form action="<!--%edit_action%-->" method="post" name="form1" id="form1">
			<div class="btn">
	        	<span class="btnleft"></span>
	            <span class="btnmiddle"><h5><!--%nom_fonction%--></h5></span>
	            <span class="btnright"></span>
	        </div>
			<div class="btn1">
	        	<span class="btnleft"></span>
	            <span class="btnmiddle"><h5><!--%nom_liste%--></h5></span>
	            <span class="btnright"></span>
	        </div>
       

		<div class="formulaire">
			<table class="tabform">
			<!--%loop:champ_input%-->
			<!--%if:isset($['label_input'])%-->
				<tr>
					<td><!--%label_input%--></td>
			      	<td><input type="text" name="<!--%input_name%-->" maxlength="<!--%maxlength%-->" class="<!--%class%-->" value="<!--%input_value%-->" disabled="disabled" /></td>
				</tr>
			<!--%endIf%--> 
		<!--%endLoop:champ_input%-->
		
		<!--%loop:champ_input_2%-->
		<!--%if:isset($['label_select_1'])%-->
								<tr>
								  	<td><!--%label_select_1%--></td>
								  	<td>
								  		<select name="<!--%select_name_1%-->">
								  		<!--%loop:options_1%-->
								  			<option value="<!--%option_value_1%-->" <!--%if:isset($['selected_1'])%-->selected="selected"<!--%endIf%-->><!--%option_name_1%--></option>
								  		<!--%endLoop:options_1%-->
									  	</select>
								  	</td>
								</tr>
		<!--%endIf%-->
		<!--%endLoop:champ_input_2%-->
		
		<!--%loop:champ_input_3%-->
			<!--%if:isset($['label_input'])%-->
					<tr>
						<td><!--%label_input%--></td>
						<td><input type="text" name="<!--%input_name%-->" maxlength="<!--%maxlength%-->" class="<!--%class%-->" value="<!--%input_value%-->"  /></td>
					</tr>
			<!--%endIf%--> 
		<!--%endLoop:champ_input_3%-->
		
		<!--%loop:champ_input_4%-->
		<!--%if:isset($['label_select_2'])%-->
								<tr>
								  	<td><!--%label_select_2%--></td>
								  	<td>
								  		<select name="<!--%select_name_2%-->">
								  		<!--%loop:options_2%-->
								  			<option value="<!--%option_value_2%-->" <!--%if:isset($['selected_2'])%-->selected="selected"<!--%endIf%-->><!--%option_name_2%--></option>
								  		<!--%endLoop:options_2%-->
									  	</select>
								  	</td>
								</tr>
		<!--%endIf%-->
		<!--%endLoop:champ_input_4%-->
		
			<table>
		</div>
		
		<div><table><tr><td>&nbsp;</td></tr></table></div>

			
			 <div class="bt1">
					<a href="#">
				    	<span class="btleft"></span>
				        <span class="btmiddle">Synthèse</span>
				        <span class="btright"></span>
				    </a>
				</div>
			<!--%if:<!--%bBouton_justificatifs%-->==true%-->
                <div class="bt1">
					<a  href="<!--%url_justificatif%-->">
				    	<span class="btleft"></span>
				        <span class="btmiddle">Justificatifs</span>
				        <span class="btright"></span>
				    </a>
				</div>
			<!--%endIf%-->
            
            
						
				<!--%if:<!--%bRetour_fonction%-->==true%-->
				<div class="bt1 retour">
					<a href="<!--%url_retour_fonction%-->">
				    	<span class="btleft"></span>
				        <span class="btmiddle">Annuler</span>
				        <span class="btright"></span>
				    </a>
				</div>
				<!--%else%-->
				<div class="bt1 retour">
					<a href="<!--%url_retour_liste%-->">
				    	<span class="btleft"></span>
				        <span class="btmiddle">Annuler</span>
				        <span class="btright"></span>
				    </a>
				</div>
				<!--%endIf%-->

					<div class="bt1 ">
						<span class="btleft"></span>
						<input type="submit" name="Valider" value="Valider" class="resizeall btmiddle"/>
						<span class="btright"></span>
					</div>
			<!-- iv class="bt1">
				<a href="#">
				<span class="btleft"></span>
				<span class="btmiddle">Valider</span>
				<span class="btright"></span></a>
			</div-->	
   </div>    
	</form>



    <div class="imgright2"></div>    
	

			

	


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</html>
